Active NPI
Elyse Miller, D.D.S.
- Dentist
- San Diego, CA
National Provider Identifier
1407239288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D009238
- Practice address
- 9135 Buckwheat St
San Diego, CA 92129-3643 - Phone
- (847) 946-8738
- NPI assigned
- Jun 30, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 107145 | CA | |
| Dentist | 122300000X | D009238 | AZ | Primary |
Addresses
Primary practice location
9135 Buckwheat St
San Diego, CA 92129-3643
Mailing address
9135 Buckwheat St
San Diego, CA 92129-3643
Phone (847) 946-8738
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151007003305 | AZ | Order and Referring Only - Other (Physician) | 9537477799 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107145 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Smiles, LLP | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Mesa, AZ
- NPI 1043407885
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1407239288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9135 BUCKWHEAT ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921293643",
"telephone_number": "847-946-8738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9135 BUCKWHEAT ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921293643",
"telephone_number": "847-946-8738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "ELYSE",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-30",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "107145",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D009238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.